Provider Demographics
NPI:1770020828
Name:INNER-CITY MUSLIM ACTION NETWORK
Entity Type:Organization
Organization Name:INNER-CITY MUSLIM ACTION NETWORK
Other - Org Name:IMAN ORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:NASHASHIBI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-434-4626
Mailing Address - Street 1:2744 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2343
Mailing Address - Country:US
Mailing Address - Phone:773-434-4626
Mailing Address - Fax:773-776-3623
Practice Address - Street 1:2744 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2343
Practice Address - Country:US
Practice Address - Phone:773-434-4626
Practice Address - Fax:773-776-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty